The Value Of Two-dimensional Ultrasound And Shear Wave Elastography In Evaluating The Curative Effect Of Neoadjuvant Chemotherapy Of Breast Cancer

Purpose Compared with pathological histology,the value of two-dimensional ultrasound was evaluated in assessing the curative effect of neoadjuvant chemotherapy(NAC)in patients with breast cancer.The application value of shear wave elastography(SWE)for early prediction of the response to NAC was investigated by observing the changes in tumor stiffness.Methods43 patients(45 lesions)with breast cancer who underwent NAC were enrolled in this study.Routine ultrasound and SWE were performed at baseline and after the end of 2,4,6,8 cycles of NAC.According to the Miller-Payne grading criteria,the sensitivity,specificity and accuracy of two-dimensional ultrasound in evaluating the efficacy of NAC and the consistency with pathology were calculated,and the lesions were divided into major pathologic response group(G3+G4+G5)and minor pathologic response group(G1+G2).The maximum elastic modulus(Emax)and the relative changes of the maximum elastic modulus(ΔEmax)were measured at baseline and after the end of 2,4,6 cycles of NAC,and the Emax trends of the two groups were compared.The ROC curves of ΔEmax at the NAC 2 and 4 cycles were drew based on the pathologic response,and the predictive value of NAC response was compared.Results? According to the Miller-Payne grading criteria,there were 33 major pathologic response lesions and 12 minor pathologic response lesions.? The difference of the maximum diameter of the 45 lesions between the baseline(3.7+1.8)cm and the end of NAC(2.0+1.4)cm was statistically significantly(t=5.846,p=0.000).The sensitivity,specificity and accuracy of two-dimensional ultrasound in evaluating the efficacy of NAC were 78.78%,66.67% and 75.56% respectively,which was consistent with pathological evaluation of NAC in breast cancer,the Kappa value was0.421.? With the prolongation of NAC,the values of Emax were significantly decreased in the two groups.The Emax of the major pathologic response group was significantly decreased at the end of 2 cycles(p<0.05),however,the value of Emax was significantly decreased at the end of 4 cycles in minor pathologic response group(p<0.05).Compared with the end of 4 cycles,there was no significant difference in the degree of decline at the end of 6 cycles in both of two groups(p>0.05).(4)The value of ΔEmax in breast cancer lesions increased gradually with the prolongation of NAC in two groups.There was significant difference in the value of ΔEmax among 2,4,6 cycles in the major pathologic response group(p<0.05).Compared with the end of 2 cycles,the value of ΔEmax increased significantly in the 4 and 6 cycles in the minor pathologic response group(p<0.05).There was no significant difference in the value of ΔEmax between the 6th week and the 4th cycles(p>0.05).The value ofΔEmax of the major pathologic response group was higher than the minor pathologic response group in each cycle significantly(p<0.05).(5)there was no significant difference in the area under the curve(AUC)between 2 cycles(AUC=0.808)and 4cycles(AUC=0.869)(Z=0.63,p=0.264).Conclusions(1)Two-dimensional ultrasound still plays an important role in evaluating NAC efficacy.(2)SWE can provide a valuable complement for two-dimensional ultrasound in the evaluation of NAC efficacy in breast cancer.There was Significant difference in trends of the Eamx values of the major pathologic response group and minor pathologic response group.(3)The value of ΔEmax in Breast cancer lesions can predict the efficacy of NAC early.